Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
J Gen Intern Med. 2022 May;37(7):1688-1696. doi: 10.1007/s11606-021-07218-1. Epub 2022 Feb 8.
Diabetes and criminal justice involvement (CJI) are both associated with poor health outcomes and increased healthcare utilization. However, little is known about the additive effects of these risk factors when combined. This study examined the individual and combined effects of diabetes and CJI on healthcare utilization.
Data from the National Survey of Drug Use and Health (2015-2019) was used to create a cross-sectional, nationally representative sample of US adults with diabetes, CJI, combination of both, or neither. Negative binomial regression was used to test the association between those with CJI and diabetes (compared to diabetes alone) and three utilization types (outpatient, ED, and inpatient) controlling for relevant sociodemographic and clinical covariates.
Of 212,079 respondents, representing 268,893,642 US adults, 8.8% report having diabetes alone, 15.2% report having CJI alone, and 1.8 % report both diabetes and lifetime CJI. After adjustment, those with diabetes and CJI had increased acute care utilization compared to those with diabetes alone (ED visits: IRR 1.13; 95% CI 1.00-1.28; nights hospitalized: IRR 1.34; 95% CI 1.08-1.67). There was no difference in outpatient utilization between those with both diabetes and CJI compared to those with diabetes alone (IRR 1.04, 95% CI 0.99-1.10).
Individuals with complex social and health risks such as diabetes and lifetime CJI experience increased acute healthcare utilization but no difference in outpatient utilization. Tailored interventions that target both diabetes and CJI are needed to reduce unnecessary utilization in this population.
糖尿病和刑事司法介入（CJI）都与健康状况不佳和增加医疗保健利用有关。然而，当这些风险因素结合在一起时，它们的综合影响知之甚少。本研究检查了糖尿病和 CJI 对医疗保健利用的单独和综合影响。
使用国家药物使用和健康调查（2015-2019 年）的数据创建了一个美国成年人的横断面、全国代表性样本，这些成年人患有糖尿病、CJI、两者兼有或两者都没有。使用负二项回归来测试 CJI 和糖尿病患者（与单独糖尿病相比）与三种利用类型（门诊、急诊和住院）之间的关联，同时控制相关的社会人口统计学和临床协变量。
在 212079 名受访者中，有 268893642 名美国成年人报告患有糖尿病，占 8.8%；报告有 CJI 的占 15.2%；报告同时患有糖尿病和终生 CJI 的占 1.8%。调整后，与单独患有糖尿病的患者相比，同时患有糖尿病和 CJI 的患者急性护理利用率增加（急诊就诊：IRR1.13；95%CI1.00-1.28；住院夜数：IRR1.34；95%CI1.08-1.67）。同时患有糖尿病和 CJI 的患者与单独患有糖尿病的患者相比，门诊就诊利用率没有差异（IRR1.04，95%CI0.99-1.10）。
患有糖尿病和终生 CJI 等复杂社会和健康风险的个体急性医疗保健利用率增加，但门诊利用率没有差异。需要针对糖尿病和 CJI 两者的定制干预措施来减少该人群的不必要利用。
